By: Christa Roberts, PT, MPT, RAC-CT and Eleisha Wilkes RN, RAC-CT

The details of proposed rule LSA #18-251 were published on October 4, 2018 by the Indiana Family and Social Services Administration, and introduces plans to revamp the Medicaid program integrity requirements. LSA #18-251 is extensive and impacts the bulk of business facets for Indiana Medicaid providers, including claims filing time limits, medical record retention, provider enrollment, sanctions, audits, and provider appeals.

LSA #18-251 consolidates existing rules, clarifies requirements and adds new program integrity requirements affecting Medicaid providers. Some of the more significant changes are as follows:

  • Currently, providers have up to one year from the date of service to submit an original claim; however, under the proposed rule, providers would have to submit claims for payment within 180 days of the date of service or the claim would be denied (effective January 1, 2019).
  • Providers will be subject to a medical record retention for financial records period of 3 years following submission to Indiana Medicaid (there is currently no record retention policy).
  • The proposed rule consolidates and adds new provider enrollment requirements.
  • Medicaid payment suspension procedures authorized by Federal law are outlined.
  • A new section is added regarding provider exclusions and readmissions (specifically, the rule lists various offenses that could result in an exclusion and sets a duration of up to 3 years for such exclusion).
  • A new section describes prepayment review processes and procedures (previously only available in agency manuals).
  • The proposed rule revises existing Medicaid overpayment provisions to align with changes in Indiana law (adds a 3-year look back period for audits initiated after July 2, 2019, though may be extended to 7 years under certain circumstances).
  • Administrative appeals procedures are consolidated and changed to align with Indiana law.

LSA #18-251 is open for public comment until the public hearing, which is preliminarily scheduled for October 26, 2018. A copy of the proposed rule can be reviewed at: www.in.gov/legislative/iac/20181003-IR-405180251PRA.xml.pdf

 


 

Speak with your doctor to find out how therapy could benefit you!

Indiana hospitals are racking up millions of dollars in penalties for having too many patients return for care within a month of discharge.

Sixty-six Hoosier hospitals—including 17 in central Indiana—will see their Medicare payments docked next year by a total of about $12 million as a result of having patients readmitted within 30 days. That’s up from $9 million in penalties three years ago.

The federal government says readmissions are often unnecessary and cost taxpayers tens of billions of dollars a year for treatments that should have been caught the first time around, or were not followed up adequately.

So for the seventh consecutive year, it is using the pressure of lower reimbursements to get hospitals to improve their numbers.

Hospitals, for their part, say they are working with patients every way they can think of to keep readmissions at a minimum.

Many are sending patients home with a thick, detailed packet of discharge instructions and a month’s worth of medications. Hospitals send nurses and aides to discharged patients’ homes to see how they are doing. In some cases, patients are given vouchers for cabs or van shuttles to get to their primary care physicians for follow-up visits.

Still, the penalties keep climbing.

“It’s getting more difficult,” said Brian Tabor, president of the Indiana Hospital Association. “Hospitals have picked a lot of the low-hanging fruit in terms of strategies. And so the work gets harder and harder.”

Click here to continue reading this article.

Hospitals are going to be looking to post-acute providers now more than ever to step-up their game. This spring, HTS launched THRIVE a turn-key system to promote successful care transitions following a post-acute stay. Our proprietary clinical programs are just another way that we move our clients forward as leaders of rehabilitation in the markets they serve. Contact us today to learn how partnering with HTS can help improve outcomes and reduce readmissions.

 


October is National Physical Therapy Month!
National Physical Therapy Month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapy may be necessary for those recovering after an illness, a fall, injury, surgery or chronic condition. Physical therapists work hard to help patients retain and regain their quality of life.

 


Speak with your doctor to find out how therapy could benefit you!

The Benefits of Contract Therapy in Senior Living

Senior living homes are going to only increase in demand in the near future. The current population is increasing in age with an explosion of baby boomers now entering their golden years. This is aided by the bubble of that generation as well as the manifold increases in medicine and technology to prolong life. Basically, this generation is the first to experience true medical breakthroughs and understanding of the human body and therefore to reach old age in greater numbers.
As this population increases, the need for assistance and therapy will also increase. It is said that by the age of 65, 7 out of 10 people will need some sort of assistance with their Activities of Daily Life or ADLs.

top uk online casinos welcome bonus codes and promotions ukcasinowelcomebonus.co.uk uk online casino welcome bonus at first deposit

This type of care, whether it is post-acute care from a fall or an illness or some sort of long-term care from a chronic disease, requires the help of a therapist. Occupational therapy, physical therapy or speech therapy are all facets of this type of assistance. The best way to deal with this growing concern is through contract therapy, or the use of a temporary, self-employed therapist who can provides services on a contract basis. There are numerous advantages to this contract therapy, especially in senior living facilities or skilled nursing facilities.

Contract Therapists Have Extensive Experience

A contract therapist has the benefit of working in a variety of fields and clinics in their career. Many contract therapists choose to work this way because of the flexibility and the diversity of the job. Contract therapists can move from any sort of work, from providing outpatient therapy to dealing with individuals with high-functioning autism (HFA). Working with a contract therapist in a senior living home means that you are working with someone who has a wealth of experience and knowledge across a broad and vast industry.
Contract therapy that is provided can be tailored to suit multiple individuals in the senior living home who might all be suffering from different ailments or conditions. Why use a therapist who only understands HFA when there are individuals with stroke paralysis, Alzheimer’s, chronic pain, dementia, and a whole host of other conditions. A contract therapist can provide solutions and effective therapy for everyone because of their vast experience and understanding.

Freedom to Start and Stop as Needed

The transitional nature of a senior home means that this year might need a therapist who specializes in physical rehabilitation, while next year, there isn’t enough demand for the position anymore. A contract therapist is hired on a contract basis, meaning that it is for a specified period of time. It could be for a few months for a particular patient, it could be a contract for a few years. The contract therapist has the freedom to start and stop as required. In dedicated clinics where a need is always constant, a full-time occupational therapist (OT) along with a certified occupational therapist assistant (COTA) would make sense. In the world of senior living homes and skilled nursing facilities, it is a much more transient work environment that benefits from a transient workforce.

Contract Therapy Appeals to More Therapists

Contract therapy attracts a great number of therapists to the field. They have the freedom to set their own hours, accept contracts that suit their lifestyle, and focus on fields in which they are interested in. The senior home appeals to a greater proportion of therapist across a wider spectrum of the industry.
Therapists who simply focus on old-age rehabilitation and care might be a narrow field of personnel. However, it is much easier to find therapist that focus on speech therapy, assistance with instrumental activities of daily living (IADLs), illness rehabilitation, physical therapy and a number of other focuses. Contract therapy appeals to a greater cross-section of therapists than simply offering a full-time position to someone who wants to work with the elderly. By selecting from a large pool of applicants, the senior home is the place that benefits by getting a higher standard of therapist.

Contract Therapy Meets a Specific Need

If there is a difficult task or a particular patient that requires specialized assistance, a contract therapist can be hired for that unique purpose. Rather than burden the full-time caregivers with the task, a dedicated professional can devote their time to a specific need. If there is an Alzheimer’s patient going through great difficulty in adjusting, contract therapy focuses in on that patient, provides them with the compensation techniques, and gives them a personalized service.

Cost Effective for the Senior Living Home

Contract therapists attract a greater hourly wage than an employed therapist, but the senior living home or skilled nursing facility sees a savings through contract therapy. Not only can it be employed when needed, the therapist is responsible for paying their own insurance and 401(k) contributions. The senior home also does not have to provide vacation days or costly benefits to the therapist. They pay their own expenses and everyone sees a greater financial outcome from this set up.

In other settings, there are a few disadvantages to using a contract therapist. In dedicated facilities or outpatient clinics, an employed therapist makes more sense. The senior home does not have the same environment as other private practices and clinics. The greatest asset the senior home can offer their residents is the use of a contract therapy to the growing number of people who will need it in the future.

For exemplary contract therapists and a greater understanding of this field, contact the team at HTS Therapy for their wealth of knowledge in this matter.